AOGS LETTER TO THE EDITOR
ullerian tract anomalies and urinary tract infections
There is a proven association between urinary tract infections
(UTI) and preterm birth. There is a recognized link between
genital and urinary anomalies (1); 30–50% of M
anomalies are associated with urinary tract defects (2). Given
this association, we determined if some women with uterine
anomalies should be monitored more closely for UTI.
We hypothesized that women with uterine anomalies were
more likely to have a UTI during pregnancy. We studied
women attending an inner-city prematurity surveillance clinic
between 2011 and 2017. Data were collected using the Preterm
Clinical Network Database (REC ref. 16/ES/0093 on 15/9/2016).
Rates of UTI (conﬁrmed with growth on urine culture) in women
with uterine anomalies were compared with a control group of
those at high-risk of preterm birth but without uterine anomalies.
In all, 82 women with uterine anomalies were analyzed, and
82 high-risk controls, consecutively collected. Anomalies included
septate (15%), subseptate (1%), didephys (11%), unicornuate
(10%), bicornuate (54%), t-shaped (1%) and arcuate (9%)
uteruses. There were low numbers and equal rates of UTI in
women with uterine anomalies and those without (4.9% vs.
4.9%, p = 1). Rates of preterm birth at <28 weeks (2.4% vs.
2.4%) and <32 weeks (3.7% vs. 2.4%, p = 0.650) were similar,
but there was a possible trend towards deliveries before 37 weeks
of gestation (22% vs. 11%, p = 0.058). Women with uterine
anomalies had signiﬁcantly fewer vaginal deliveries (34.2% vs.
59.0%, p = 0.003) and more elective cesareans (29.3% vs. 14.8%,
p = 0.042).
In our cohort of high-risk women, uterine anomalies were
not a risk factor for UTI during pregnancy. They can be man-
aged as other high-risk women and do not require extra screen-
ing for UTI compared with other high-risk women. They have
similar rates of early preterm birth compared with others in the
high-risk clinic and so require management in a Prematurity
Surveillance Clinic. They were signiﬁcantly more likely to have a
cesarean section rather than vaginal delivery – likely due to
obstetric risk factors, agreeing with other studies (3).
There were very low rates of UTI in women with uterine
anomalies, suggesting that this does not increase the risk of UTIs
due to associated renal tract abnormalities. Additional risks in
this group are not associated with UTIs. Women with uterine
anomalies do not require extra screening for UTI. However, they
remain at high risk for preterm birth and should be under the
care of a Preterm Surveillance Clinic.
Penelope J. Teoh*
, Alexandra Ridout, Jenny Carter and
Andrew H. Shennan
Department of Women and Children’s Health, School of Life
Course Sciences, King’s College, London, UK
Penelope Jayne Teoh
1. Fedele L, Bianchi S, Agnoli B, Tozzi L, Vignali M. Urinary
tract anomalies associated with unicornuate uterus. J Urol.
2. Wang S, Lang JH, Zhou HM. Symptomatic urinary
problems in female genital tract anomalies. Int Urogynecol
3. Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA,
Cahill AG. Congenital uterine anomalies and adverse
pregnancy outcomes. Am J Obstet Gynecol.
ª 2017 Nordic Federation of Societies of Obstetrics and Gynecology, Acta Obstetricia et Gynecologica Scandinavica 97 (2018) 357